Real-time Elastography Research Articles

A Combination of Ultrasonography and Real Time Elastography (RTE) in Differentiating benign and Malignant Thyroid Nodules, Does It Help?

A Combination of Ultrasonography and Real Time Elastography (RTE) in Differentiating benign and Malignant Thyroid Nodules, Does It Help?

Real-Time Elastography in the diagnosis of prostate cancer: a systematic review.

To evaluate the diagnostic accuracy of real-time elastography as a method for detecting prostate cancer. Relevant studies applying real-time elastography as the diagnostic modality and biopsy as the reference standard, published by March 1, 2018 were retrieved from PubMed, EMBASE, Web of Science and Cochrane Library databases. Two independent reviewers inspected all these articles to confirm the matching of the inclusion criteria. One reviewer with methodological expertise extracted the data from the included studies. Sensitivity, specificity and diagnostic odds ratio (DOR) were used to obtain overall estimates. Randomized effect method, meta-regression and subgroup analysis were performed. Twenty-four studies out of 1156 identified articles met the inclusion criteria. Three groups were set: analysisby patient (Group 1), by core (Group 2), and by image (Group 3) and subgroups set in Group 1. The pooled estimate ofreal-time elastography sensitivity/ specificity/ DOR calculated with the identical P-value 0.00. Within subgroups "Asia" and"PSA>=10 ng/ml", the pooled sensitivity, specificity and DOR were 0.83, 0.65 (p=0.01, I2=73.40%; p=0.02, I2=69.5%), 0.80, 0.82 (p=0.66, I2=0.00%; p=0.58, I2=0.00%) and 20.2, 8.67 (p=0.09, I2=54.2%; p=0.20, I2=35.5%), respectively. In these three groups, the areas under the SROC curve were 0.7417, 0.9246, and 0.6213 independently. Real-time elastography is a promising, reliable modality for the non-invasive diagnosis of patients with prostate cancer. The diagnostic accuracy of real-time elastography correlates tightly to the presence of higher PSA level and may help avoid unnecessary biopsy. It seems to be a useful tool in systemic biopsy.

Methotrexate therapy is not associated with increased liver stiffness and significant liver fibrosis in rheumatoid arthritis patients: A cross-sectional controlled study with real-time two-dimensional shear wave elastography

ObjectiveTo explore the significance of the association between treatment with methotrexate (MTX) and liver stiffness in rheumatoid arthritis (RA) patients. MethodsWe enrolled 140 consecutive RA patients under MTX treatment (MTX-treated RA; mean treatment duration: 6.2 years; mean MTX cumulative dose: 4.67 g), 33 RA patients naive to MTX (MTX-naive RA) and 100 age and sex-matched healthy blood donors (HD). Liver stiffness was assessed by real time two-dimensional shear wave elastography, with values ≥7.1 Kilopascals (kPa) defining significant liver fibrosis. ResultskPa values in HD (4.32 ± 0.7) were lower than that in MTX-naive RA (4.92 ± 0.8) and MTX-treated RA (4.85 ± 0.9, p < .0005 for trend). On the contrary, the difference in kPa between MTX-naive and MTX-treated RA was not significant (p = .89). Similarly, liver stiffness was not significantly different across strata of cumulative MTX dose (4.95 ± 0.7 kPa in MTX <1 g, 4.90 ± 1.1 kPa in MTX 1–3 g and 4.80 ± 0.9 in MTX >3 g, p = .610). Significant liver fibrosis was diagnosed in 4 patients in the MTX-treated RA (highest kPa value = 7.6; no liver function test abnormalities or clinical signs of hepatic failure) and in none in both the MTX-naive RA and HD groups (p = .145). ConclusionLiver stiffness values, although within the normal range, are significantly higher in RA patients vs. controls, irrespective of MTX treatment. RA patients taking MTX do not have a higher prevalence of significant liver fibrosis when compared to MTX naive RA patients and the general population.

Evaluation of Optic Nerve Head Biomechanical Properties in Pseudoexfoliation Glaucoma with Real-time Elastography.

To investigate the biomechanical properties of the optic nerve head in patients with Pseudoexfoliation (PEX) glaucoma using Real-time Elastography (RTE) and to compare these results with those of Primary Open Angle Glaucoma (POAG) patients and healthy subjects. Twenty eyes of 20 PEX glaucoma patients (PEX group), 20 eyes of 20 POAG patients (POAG group), and 20 eyes of 20 healthy subjects (control group) were enrolled in this prospective study. The strain Ratios of Orbital Fat to Optic Nerve head (ROFON) and lateral rectus muscle to optic nerve head (RLRON) were determined. Comparisons were performed using Chi-square, Kruskal Wallis, Mann-Whitney U, and One-way ANOVA tests. The strain ratios of orbital fat to optic nerve head were 2.34, 6.85 and 1.76 in PEX glaucoma, POAG, and control groups, respectively (p<0.001). The strain ratios of the lateral rectus muscle to the optic nerve head were 0.51, 0.82, and 0.55 in PEX glaucoma, POAG, and control groups, respectively (p=0.256). The strain ratios of orbital fat to optic nerve head were different in PEX glaucoma patients than in POAG and control groups. RTE can provide biomechanical assessment of the optic nerve head in a non-invasive, quick, easily accessible, and user-friendly manner.

Quantitative Analysis of Ultrasound Tissue Diffusion Elastography in The Diagnosis of Benign and Malignant Prostate Lesions.

This study aims to evaluate the value of quantitative analysis of ultrasound real-time tissue diffusion elastography in the diagnosis of benign and malignant prostate lesions. From March 2010 to June 2013, 52 patients suspected with prostate cancer based on laboratory or clinical test results and underwent prostate biopsy in our hospital were enrolled into this study. The age of these patients ranged between 45-82 years, with an average age of 67.2 ± 6.8 years. All patients underwent transrectal real-time ultrasound elastography (TRTE) before biopsy. A total of 63 prostate nodules were detected, and the 11 elastic characteristic quantities of these nodules were quantitatively analyzed via tissue diffusion quantitative analysis. The results of ultrasonography were compared with the results of operation and pathology. Among these 11 characteristic quantities, which include the mean (MEAN) and standard deviation (SD), blue area ratio (AREA%), complexity (COMP), kurtosis (KURT), skewness (SKEW), contrast (CONT), equality (ENT), entropy (IDM), consistency (ASM) and correlation (CORR), except for COMP and CORR, the differences in other nine characteristic quantities between benign and malignant prostatic nodules were statistically significant (P<0.05). Among these, the AREA% and MEAN had the highest correlation, which were 0.791 and -0.791, respectively. The Youden's index (sensitivity and specificity) of AREA% in the ROC curves was the highest, the cutoff value was 80.65% for the diagnosis of prostate cancer, sensitivity was 87.9%, and specificity was 96.6%. Quantitative analysis of ultrasound real-time tissue diffusion elastography is helpful in the diagnosis of benign and malignant prostate lesions, provides a relatively accurate evaluation method in clinical practice, and has broad application prospects.

Comparative Analysis of the Quantitative Parameter Method and Elasticity Color Mode Method for Real-Time Shear Wave Elastography in the Diagnosis of Benign and Malignant Solid Breast Lesions

Ultrasound elastography is a new technique that has been developed rapidly in recent years and has attracted much attention. It can reveal the histological characteristics of a lesion by detecting the elasticity of the tissue

The Passive Mechanical Properties of Muscles and Tendons in Children Affected by Osgood-Schlatter Disease

Osgood-Schlatter disease (OSD) is a sports-related disorder involving apophysitis, which affects the tibial tuberosity. The identification of factors related to OSD is important for its prevention and early recovery from the disease. This study aimed to compare the passive mechanical properties of the muscle-tendon unit in children affected by an OSD and healthy children, by using ultrasound real-time tissue elastography. Eighteen legs affected by OSD (OSD group) and 42 healthy legs (control: CON group) were assessed. The elasticity was obtained from the quadriceps muscles and patella tendon (PT) using real-time tissue elastography. The strain ratio (SR; muscle or tendon/reference ratio: strain rate of the muscle or tendon divided by that of the reference material) was calculated as an indicator of the elasticity of the tissue of interest. The SR of the PT in the OSD group was significantly lower than that in the CON group (P<0.05). We found no significant difference between the groups in terms of the SR value of all muscles (P>0.05). The results suggest that a PT with a lower SR may be associated with an OSD and that the passive mechanical properties of the quadriceps muscles have limited association with an OSD. Level IV.

Real-time ultrasound elastographic evaluation of extraocular muscle involvement in Graves’ ophthalmopathy

ABSTRACTPurpose: To evaluate the affected extraocular muscles (EOMs) of patients with Graves’ ophthalmopathy (GO) using real-time ultrasound elastography (UE) and to compare these results with those of healthy subjects.Methods: This prospective, comparative case series included 70 eyes of 35 patients with moderate-to-severe GO with type 2 orbitopathy (myogenic variant) according to their computed tomography (CT) scans. Forty-six eyes of 23 healthy subjects were evaluated as the control group. The strain ratio of orbital fat to medial rectus was calculated as the ratio of the medial rectus to orbital fat tissue, and the strain ratio of orbital fat to lateral rectus was calculated as the ratio of lateral rectus to orbital fat tissue.Results: The strain ratio of orbital fat to medial rectus was 3.03 ± 1.25 (range: 1.05–5.07) in the GO group, and 0.54 ± 0.20 (range: 0.14–1.08) in the control group (p = .0001). The strain ratio of orbital fat to lateral rectus was 0.97 ± 0.29 (range: 0.56–1.55) in the GO group, and 0.63 ± 0.23 (range: 0.18–1.09) in the control group (p = .0001).Conclusion: By using real-time UE, we found the medial and the lateral recti of GO patients to be stiffer compared to those of healthy subjects.

Clinical Value of the Elastographic Q-Analysis Score in Assisting Real-Time Elastography-Guided Prostate Biopsy: A Retrospective Study of 125 Patients.

This study aimed to evaluate the clinical value of the elastographic Q-analysis score (EQS) in assisting real-time elastography- and transrectal US-guided prostate biopsy. A total of 125 patients with 301 lesions were enrolled in this study; all were confirmed by pathologic results. The patients underwent transrectal US and elastographic examinations before biopsy. Elastographic Q-analysis score analysis software was used for measuring the mean EQS of the elastic images. First, the suspicious regions on elastography underwent biopsy. Then 12-core systematic prostate biopsy was performed. An EQS curve was used to calculate the mean EQS, and a receiver operating characteristic curve was drawn to find the cutoff point for the EQS to predict prostate cancer. Of the 301 lesions in this study, 125 were malignant, and 176 were benign. The mean EQS values of benign and malignant lesions ± SD were 1.47 ± 0.75 and 2.98 ± 1.06, respectively. The difference was statistically significant (P < .05). The area under the receiver operating characteristic curve was 0.87. When the cutoff point was 1.95 for diagnosing malignant and benign lesions, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 83.5%, 84.4%, 76.8%, 89.2%, 5.35, and 0.20. The EQS could be used as a way to predict benign and malignant lesions and thus could serve as guidance for adding targeted biopsy.

The role of elastography in the characterization of solid breast masses

Purpose: In this prospective study, it is aimed to correlate the histopathological evaluation findings of the patients having lesions referred for excisional biopsy due to BI-RADS (Breast Imaging Reporting and Data System) 3, BI-RADS 4, BI-RADS 5 lesions detected by ultrasonography, with their elastography elasticity index values, to investigate the role of elastography and to determine elastography elasticity index cut-off value for the malignant benign differentiation of these lesions. Material and Method: In 1 November 2008-28 February 2009, seventy female patients referred to the Department of Radiology in Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, who were found to have solid breast lesions by ultrasonography, were evaluated. The colour score and elasticity index values of the masses were assessed. Results: Statistically, elasticity index cut-off value for the malignant-differentiation of the lesions was calculated as 4.05. Also for the same differentiation, the sensitivity and specificity of elastography were calculated as 90% and 97%, respectively, whereas positive predictive value and negative predictive value were determined as 90% and 97.5%, respectively. Conclusion: Real-time elastography is a quite useful imaging technique, that is useful for benign malignant differentiation of suspicious breast lesions with high sensitivity and specificity as well as high positive and negative predictive values.

Accuracy of real-time shear wave elastography in the assessment of normal small intestine mucosa in dogs.

The aim of the study was to assess the physiological stiffness of the normal canine jejunal mucosa based on shear wave elastography. The study was carried out on 60 dogs. In all the animals studied, the abdominal ultrasound was carried out using the SuperSonic Imagine Aixplorer system. The site of the jejunal elastography was determined using standard ultrasonography and all the measurements were carried out thrice. The stiffness of the area examined was determined during each measurement. Mean values were calculated based on the results obtained. The normal stiffness of the jejunal mucosa ranged from 1.305 kPa to 9.319 kPa (mean 5.31 ± 2.04 kPa). Based on our findings, we determined the range of normal values of the jejunal mucosal stiffness in healthy dogs. In addition, shear wave elastography was found to be safe and easy to perform. Moreover, it did not require anaesthesia or patient immobilisation for long periods.

Optimization of phase-resolved optical coherence elastography for highly-sensitive monitoring of slow-rate strains

A realization of real-time optical coherence elastography for mapping small-amplitude, slowly varying strains is discussed. The technique is based on the recently developed ‘vector’ method for estimating interframe phase-variation gradients by considering complex-valued signals in optical coherence tomography (OCT) as vectors in the complex plane. This method is very tolerant to various measurement noises and allows for mapping both fairly fast and large, as well as rather small and slow-rate strains. Evaluation of strains slowly varying on intervals of ~tens of minutes is important for the emerging techniques of laser-assisted modification of collagenous tissues (e.g. for estimating post-reshaping stability of laser-modeled cartilaginous implants) or for studying slow deformations of osmotic origin in biological tissues. Optimization of the interframe interval for improving signal-to-noise ratio (SNR) in OCE-mapping of slowly-varying strains is discussed and experimentally demonstrated. The ultimate stability of strain estimation with the designed OCT setup is experimentally estimated using stable phantoms. Examples of the spatially resolved maps of slowly-varying strains are presented.

Sa1735 – Baseline Bowel Stiffness on Real-Time Shear Wave Ultrasound Elastography Predicts Response to Infliximab in Patients with Crohn's Disease

Sa1735 – Baseline Bowel Stiffness on Real-Time Shear Wave Ultrasound Elastography Predicts Response to Infliximab in Patients with Crohn's Disease

Impact of non-selective beta blockers on portal hypertension and hepatic elasticity in hepatitis C virus-related liver cirrhosis.

Portal hypertension and its complications are the leading causes of morbidity and mortality in patients with liver cirrhosis. Noninvasive assessment of liver stiffness had been an effective tool for assessment of fibrosis progression in chronic liver disease. It was intended to assess liver stiffness measurement (LSM), portal vein diameter (PVD), splenic bipolar diameter (SD), and the platelet count/spleen diameter (PC/SD) ratio in patients who test positive for the hepatitis C virus (HCV) and to study the impact of non-selective beta blockers (NSBB) on the grade of esophageal varices (EVs) and liver elasticity. Subjects were 80 patients with Child-Pugh grade A or B compensated cirrhosis who tested positive for HCV. All of the patients underwent a laboratory workup including AFP, HCV antibodies, HCV RNA, HBsAg, LSM according to real-time elastography, upper gastrointestinal endoscopy (UGIE) to detect and grade EVs, calculation of the PC/SD ratio, and measurement of the PVD and SD according to real-time abdominal ultrasonography. All patients were given the maximum tolerated dose of NSBB for three months, and UGIE, LSM, PC/SD, PVD, and SD were subsequently reassessed and reported. LSM and the PC/SD ratio were exceptional noninvasive tools for prediction of significant EVs (grade ≥ II, p < 0.001) with a sensitivity 82.4% and a specificity 82.6% at a cutoff point 18 kPa for LSM, and a sensitivity 94.1% and specificity 69.6% at a cutoff point 880 for the PC/SD ratio. LSM is highly correlated with PVD, the PC/SD ratio, SD, and the Child-Pugh score. NSBB significantly decreased PVD. The percent change in PVD significantly correlated with LSM, the grade of EVs, and SD. Findings indicated that LSM is a noninvasive, rapid, and reproducible tool with which to detect portal hypertension and EVs. NSBB therapy can effectively decrease PVD and may consequently improve the EV grade with no significant impact on LSM in patients with liver cirrhosis.

Machine Learning-Assisted System for Thyroid Nodule Diagnosis.

Background: Ultrasound (US) examination is helpful in the differential diagnosis of thyroid nodules (malignant vs. benign), but its accuracy relies heavily on examiner experience. Therefore, the aim of this study was to develop a less subjective diagnostic model aided by machine learning. Methods: A total of 2064 thyroid nodules (2032 patients, 695 male; Mage = 45.25 ± 13.49 years) met all of the following inclusion criteria: (i) hemi- or total thyroidectomy, (ii) maximum nodule diameter 2.5 cm, (iii) examination by conventional US and real-time elastography within one month before surgery, and (iv) no previous thyroid surgery or percutaneous thermotherapy. Models were developed using 60% of randomly selected samples based on nine commonly used algorithms, and validated using the remaining 40% of cases. All models function with a validation data set that has a pretest probability of malignancy of 10%. The models were refined with machine learning that consisted of 1000 repetitions of derivatization and validation, and compared to diagnosis by an experienced radiologist. Sensitivity, specificity, accuracy, and area under the curve (AUC) were calculated. Results: A random forest algorithm led to the best diagnostic model, which performed better than radiologist diagnosis based on conventional US only (AUC = 0.924 [confidence interval (CI) 0.895-0.953] vs. 0.834 [CI 0.815-0.853]) and based on both conventional US and real-time elastography (AUC = 0.938 [CI 0.914-0.961] vs. 0.843 [CI 0.829-0.857]). Conclusions: Machine-learning algorithms based on US examinations, particularly the random forest classifier, may diagnose malignant thyroid nodules better than radiologists.

Comparison of median nerve stiffness with and without rheumatoid arthritis by ultrasound real-time tissue elastography: A propensity score matching study

Objectives: This study aimed to compare median nerve stiffness measured by ultrasound real-time tissue elastography in patients with and without rheumatoid arthritis (RA and non-RA groups, respectively).Methods: Altogether, 402 hands of 201 RA group and 222 hands of 111 non-RA group were included in the study. Ultrasonography was performed to evaluate the circumference, cross‐sectional area (CSA) and strain ratio as an elasticity of the median nerve at the inlet level of the carpal tunnel and the proximal portion of the carpal tunnel inlet. Using propensity score matching, the difference between RA and non-RA group were analyzed.Results: After propensity score matching, 135 hands in 104 RA group and 70 non-RA group were finally analyzed. There were no significant differences in the circumference and CSA of the median nerve between the two groups. The strain ratio of the median nerve was significantly higher in RA group than in non-RA group only at the inlet of the carpal tunnel level.Conclusions: The nerve stiffness in patients with RA measured by ultrasound real-time tissue elastography was higher than without RA. Inflammatory condition of the flexor tendon and wrist joint in patients with RA may generate fibrotic changes in the median nerve.Trial registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000015314.

Real-Time Tissue Elastography in Epidermal Cyst: along with Enhanced MRI and Elasticity Features of Peripheral Rim

The development of more potent machines and high-frequency probes has contributed to a daily practice and research study in the dermatologic field...

Application of real-time shear wave elastography in the assessment of torsional cervical dystonia.

This study aimed to investigate the value of real-time shear wave elastography (SWE) in the assessment of torsional cervical dystonia (TCD). Ninety healthy volunteers and 30 TCD patients were recruited, and elastography was performed at musculi sternocleidomastoideus (MSD) and musculi splenius capitis (MSC). Mean shear elastic modulus of right MSD and MSC in healthy controls and bilateral MSD and MSC in TCD patients was determined. The thickness of MSD and MSC of affected muscles was measured in TCD patients. In TCD patients, the mean shear elastic modulus of affected MSD and MSC was significantly higher than that of corresponding normal muscles (P<0.01) and that of controls (P<0.01). The diagnostic threshold was 24.9 kPa for MSD and 25.07 kPa for MSC (for MSD and MSC, the area under ROC was 0.979 and 0.979, with a sensitivity of 90% and 91.3%, and a specificity of 95.6% and 96.7%, respectively). The elastic modulus of neither affected nor normal MSD and MSC was significantly related to age and body mass index (P>0.05). The shear elastic modulus of affected MSD and MSC was positively related to the peak electromyography (r=0.83-0.73, P<0.01). The thickness of affected MSD and MSC was significantly thicker than that of corresponding normal muscles in TCD patients (P<0.01). Real-time SWE can identify the difference in shear elastic modulus of MSD and MSC between the affected and normal side in TCD patients, indicating important diagnostic value in the assessment of muscular status for these patients.

Real-time shear wave elastography in differential diagnosis of benign and malignant thyroid nodules

Objective This study aimed to discuss the performance and impact factors of shear wave elastography (SWE) for differential diagnosis of thyroid nodules (TN). Methods 84 TNs were included in the study. The SWE indices of Emax, Emin and Emean for the region-of-interest were calculated and analyzed. All TNs were divided into subgroups ( 10.0 mm group) according to the size and whether it has calcification (calcification group and non-calcification group). We compared the elasticity indices between subgroups and analyzed the diagnostic performance of SWE with different impact factors. Results There were 40 benign TNs and 44 malignant TNs. The Emean and Emax of malignant TNs were significant higher than those of benign TNs (P=0.000). Both the Emean and Emax of were significant higher in TNs with presence of calcification (P=0.036, P=0.031). The receiver operator characteristic (ROC) curve showed that the diagnostic sensitivity was 94.7% in the >10.0 mm group with Emean >19.6 kPa as the cut-off value, and 92.9% in non-calcification group with Emean >21.1 kPa as the cut-off value. Conclusions The elastic modulus of malignant TNs was significant higher than benign TNs. The presence of calcification may increase the stiffness of TNs. The diagnostic performance of SWE was better in TNs with those sizes >10 mm and TNs with absence of calcification. Key words: Ultrasonography; Elasticity imaging techniques; Thyroid nodule

Could semiquantitative analysis of real-time ultrasound elastography distinguish more liver parenchyma alterations of nonalcoholic fatty liver disease in patients with polycystic ovary syndrome?

Nonalcoholic fatty liver disease is the commonest diffuse liver disease, of which women with polycystic ovary syndrome are at an increased risk. The aim of the present study was to assess the diagnostic value of the semiquantitative strain parameters of real-time ultrasound elastography for nonalcoholic fatty liver disease in patients with polycystic ovary syndrome. Thirty-five polycystic ovary syndrome patients with nonalcoholic fatty liver disease, 70 polycystic ovary syndrome patients without nonalcoholic fatty liver disease, and 70 healthy female controls of reproductive age were included. All participants underwent ultrasonic examination and semiquantitative analysis of real-time ultrasound elastography of the liver. Main semi quantitative strain parameters, such as average strain value, differed significantly among groups polycystic ovary syndrome with nonalcoholic fatty liver disease, polycystic ovary syndrome without nonalcoholic fatty liver disease, and control (87.02 ± 10.16 vs. 96.31 ± 11.44 vs. 104.49 ± 7.28, p < 0.001). Clinical and laboratory parameters differed significantly between the two subgroups with low or high average strain value. For diagnostic value of average strain value for elevated aminotransferase, the area under the curve was 0.808 (range 0.721-0.895). In multiple linear regression analysis, polycystic ovary syndrome, waist circumference, and metabolic syndrome were stand-alone independent factors associated with average strain value among subjects without nonalcoholic fatty liver disease. Semiquantitative real-time ultrasound elastography analysis could distinguish liver parenchyma alterations in patients with polycystic ovary syndrome more sensitively. The diagnostic value of the proposed method for nonalcoholic fatty liver disease need further research.